Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

Subclmical depression and role fulfillment in domestic settings: Spurious relationships,imagined problems,or real effects?

Considerable evidence has accumulated in support of the hypothesis that subclinical depression may inhibit role performance in important ways. However, interpersonal stress and marital discord often precede the development of depressive symptomatology and may independently predict deficits in family role functioning. In addition, cognitive theories suggest that persons with subclinical depression may report poor role functioning even in the absence of any real performance deficits. The current research examines the possibility (1) that the effect of depression on the fulfillment of important family roles is attributable to previously unmeasured contextual variables of ongoing interpersonal stress and/or relationship dissatisfaction or, alternatively, (2) that this relationship is the result of depressive distortion associated with self-report of symptoms and performance. Multiple regression analyses of interview data collected from 495 community-dwelling adults found, however, that depression is related to role functioning beyond any spurious effects attributable to interpersonal stress, spousal stress, or marital satisfaction. In addition, the effect of depression persists when collateral reports of role functioning utilized. Accordingly, it appears that subclinical depression is related to decrements in role performance, and this effect is not entirely due to contextual elements or shared method variance between self-report measures.The authors acknowledge research support from Research Grants R01-AA-07250 and R01-AA-07218 from the National Institute on Alcohol Abuse and Alcoholism, Research Grant R01-DA-07417 from the National Institute on Drug Abuse, and National Institutes of Mental Health Grant A-41487-07.     

Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

Whose Gene Is It? A Case Discussion About Familial Conflict over Genetic Testing for Breast Cancer

A multidisciplinary group of genetic and other professionals discuss a complex case of familial conflict over access to genetic information. One twin wishes to know the results of her deceased mother's tests for BRCA1 mutations; a second twin objects to researchers making this information available. As the case discussion unfolds, the apparent facts of this case are called into question and the lines of ethical certainty become less clear.     

The responsibility of engineers, appropriate technology, and lesser developed nations

Projects importing technology to lesser developed nations may raise five important concerns: famine resulting from substitution of cash crops for subsistence crops, the use of products banned in the United States but permitted overseas, the use of products safe in the U.S. but unsafe under local conditions, ecological consequences of technological change, and cultural disruption caused by displacing traditional ways of life. Are engineers responsible for the foreseeable hunger, environmental degradation, cultural disruption, and illness that results from the project? Are engineers guilty of paternalism if they refuse to accept the project for that reason? Criteria are given to help engineers assess the extent of their responsibility when working in lesser developed nations.     

DIE MARXISMUS – DEBATTE IM “SILBERNEN ZEITALTER”

Im Anfang des 20.Jahrhunderts unterzog eine Reihe von jungen, später berühmt gewordenen Philosophen den Marxismus einer tiefen Kritik. Ihnen ist es gelungen, wichtige Defekte der revolutionären Doktrinen aufzudecken und ihre verhängnivsollen Konsequenzen vorwegzunehmen. Diese Kritik ist auch für die gegenwärtige geistig-politische Situation aktuell.     

TRACING A TRAJECTORY

Abstract. Theology and ethics intersect with sciences at different points depending upon whether the scholars involved are interested in, for example, general epistemological issues or practical moral judgments. The intersection affects theology and ethics in different ways, depending upon various commitments or resistances on the part of theologians. The author surveys his own writings to show how openness to the sciences has had an impact on various phases of his work and what issues remain somewhat unresolved.     

Marital attributions in spouses of depressed patients

Causal attributions (i.e., locus, stability, globality) and responsibility attributions (i.e., bad intent, selfish motivation, blame) were assessed in the spouses of 27 depressed psychiatric inpatients and 30 nondepressed dyads to test predictions derived from Hooley's (1987) symptom-controllability model of marital distress. Results indicated that (1) depressed patients and their spouses were less dyadically adjusted than nondepressed spouses, (2) causal and responsibility attributions about depressive behaviors predicted lower dyadic adjustment, and (3) attributions of causality mediated the relationship between group status (depressed or nondepressed) and dyadic adjustment among spouses who had higher expectations for their partner to change. Results suggest that among spouses with a high expectancy for change, depression may be a risk factor for marital distress.     

Fallacies and moral dilemmas

The continuing debate between utilitarians and deontologists often takes the form of disagreement over how particular moral dilemmas are to be resolved, but protagonists on both sides tend to overlook the possibility of resolving a dilemma with remainder, such as regret. The importance of remainder is also overlooked by critics of some absolutist ways of resolving or slipping between the horns of certain moral dilemmas. Moreover, deontologists, if not utilitarians, can be criticised for overlooking the possibility that, according to their theory, some dilemmas may be irresolvable. Virtue ethics, with its concentration on the agent, readily accommodates both mention of remainder and irresolvable dilemmas, and yields a specification of tragic dilemmas which the other two theories might like to take on.